Carloslp

Hematologist at Hospital Hermanos Amejeiras. Acute leukemia, Lymphoma & Stem Cell Transplantation.

[Carloslp @Carl3roP]

@jorgenavas84 Good morning

[Mohamad Mohty @Mohty_EBMT]

The power of cellular immunotherapy ! Impressive results! Congratulations !
⁦@JCO_ASCO⁩ ⁦@TheIACH⁩ ⁦@COMyCongress⁩ ⁦@ASCO⁩

[Dr. Chokri Ben Lamine @abouabdrahman0]

🧵 #MultipleMyeloma 2025 Mayo Clinic Flowcharts Summary 🩸🧬
By Dr. S. Vincent Rajkumar #MM #Oncology #ASCT #Bispecifics #Hematology 🧪

⸻

1️⃣ Newly Diagnosed, Transplant-Eligible
💠 Standard-Risk
→ Induction: Dara-VRd or Isa-VRd x 3–4
→ Early ASCT or Stem cell cryo + 4–5 more cycles
→ 🔁 Lenalidomide maintenance

💠 High-Risk
→ Same induction
→ Early ASCT
→ 🔁 Doublet maintenance

💠 Unavailable options
→ Use VRd x 3–4
→ Early ASCT
→ Maintenance:
 • Len for standard
 • VR for high-risk

📌 PI–Imid or Anti-CD38 Imid

⸻

2️⃣ Newly Diagnosed, Transplant-Ineligible
💠 Ideal Fit → Dara/Isa-VRd x ~8 cycles
 • Standard: Len maint
 • High-risk: Doublet maint

💠 Frail
→ DRd or Isa-Rd x ~8
→ Continue 1–2 tolerated drugs

💠 Unavailable options
→ VRd x ~8
→ Maintenance: Len (standard), VR (high-risk)

⸻

3️⃣ First Relapse (~10 RCTs)
🔹 Not Refractory to Lenalidomide
 • If not refractory to CD38 → DRd
 • If refractory to CD38 → KRd (preferred), ERd/IRd (alts)

🔹 Refractory to Lenalidomide
 • Not refractory to CD38 → DKd / Isa-Kd / DPd / Isa-Pd
 • Refractory to CD38 → KCd / KPd (preferred), VCd / EPd (alts)

🧬 Consider salvage ASCT if not done before
📅 Consider 2nd ASCT if >36 months remission after 1st

⸻

4️⃣ Second or Higher Relapse
🔹 Triple-Class Refractory (IMiD, PI, CD38)
🧬 BCMA-targeting:
 • Bispecifics: Teclistamab, Elranatamab
 • CAR-T: Cilta-cel, Ide-cel
 • Belantamab (if available)

🔹 Penta-Refractory incl. BCMA
💊 Existing: Dara-VCd, KCd, Elo, Selinexor, Veneto, Bendamustine, VDT-PACE
🧪 Trials:
 • Talquetamab
 • Iberdomide, Mezigdomide
 • New bispecifics (e.g. Cevostamab)
 • Novel CAR-Ts, monoclonals, ADCs

⸻

🧠 A must-know roadmap for all hematologists 🧬
📸 Source: Dr. Rajkumar SV, Mayo Clinic (2025)

#Myeloma #MMsm #MultipleMyeloma #HemeOnc #CAR_T #BCMA #Transplant #SOHO25 #Hematology #ASH25 #Bispecifics

[Vincent Rajkumar @VincentRK]

Solitary plasmacytoma.
One lesion, but 3 possible entities with differing prognosis in the differential diagnosis.

Outcomes and management. ⁦@MayoMyeloma⁩ ⁦@BloodAdvances⁩ ⁦@ASH_hematology⁩ https://t.co/f1ZE9EBv8R

[Saurabh Zanwar @ZanwarSaurabh]

Is risk-adapted therapy ready for prime time in Multiple Myeloma? Check out our recent review looking at risk definitions and MRD-guided therapy for MM

@myelomaMD @MayoMyeloma
Free article link here:
https://t.co/lP2RXp1Cb9

[Carloslp @Carl3roP]

#NuevaFotoDePerfil

[Dr. Chokri Ben Lamine @abouabdrahman0]

PICC Line Insertion: Comprehensive Review for Hematology

1️⃣ Indications for PICC Lines in Hematology
•Chemotherapy Requiring PICC:
•Vesicant drugs: Anthracyclines (e.g., Doxorubicin, Daunorubicin), Vincristine, Cisplatin.
•Irritants: Hypertonic saline, parenteral nutrition, amphotericin B.
•Continuous infusions: Cytarabine, Etoposide, Methotrexate (high-dose regimens).
•Prolonged treatment: Consolidation/maintenance phases requiring repeated cycles.
•Stem Cell Transplant: Conditioning regimens (e.g., Busulfan, Fludarabine).
•High-flow drugs: Antibiotics (e.g., Vancomycin), antifungals, or supportive care agents.

2️⃣ Complications

Early Complications:
•Insertion-related:
•Hematoma, arterial puncture, or catheter malposition.
•Pain or swelling at the insertion site.
•Pneumothorax: Rare in PICC lines, but can occur if improperly positioned.

Late Complications:
•Thrombosis:
•Incidence higher in hematology patients due to hypercoagulability (e.g., in malignancies).
•Signs: Swelling of arm/neck, catheter dysfunction.
•Infection:
•Catheter-Related Bloodstream Infections (CRBSI):
•Most common pathogens: Coagulase-negative Staphylococcus, Gram-negatives.
•Risk increases with prolonged use or inadequate hygiene.
•Catheter Occlusion:
•Caused by clots, drug precipitates, or fibrin sheath formation.
•Malposition/Migration:
•Tip migration can lead to dysfunction or arrhythmias.

3️⃣ Precautions
•Before Insertion:
•Thrombocytopenia: Ensure platelets >50,000/mm³; transfuse if needed.
•Neutropenia: High infection risk; strict aseptic technique.
•Anticoagulation: For patients on anticoagulants (e.g., due to VTE), assess bleeding risk.
•Allergy: Check for allergies to catheter materials (e.g., latex).
•During Insertion:
•Aseptic Technique: Follow sterile barrier precautions (gown, gloves, drapes).
•Imaging: Use ultrasound guidance for vessel identification.
•Tip Positioning: Confirm placement in the lower third of the SVC or cavoatrial junction via fluoroscopy or post-procedural chest X-ray.
•After Insertion:
•Securement: Use a stabilization device to prevent migration.
•Flush Protocol: Regular flushing with saline/heparin to maintain patency.
•Dressing: Transparent dressings; change weekly or when soiled.

4️⃣ Practical Positioning Tips
•Vessel Selection:
•Basilic vein: Preferred due to larger diameter and straight course.
•Cephalic vein: Secondary choice; smaller and more tortuous.
•Optimal Tip Position:
•Verify at the cavoatrial junction (CAJ) to avoid arrhythmias or venous thrombosis.
•Avoid placement in the right atrium (risk of perforation).
•Arm Positioning During Insertion:
•Supine position with the arm abducted at a 90-degree angle.

5️⃣ Exam-Wise High-Yield Tips
•Indications for PICC: Repeated IV access for chemotherapy, irritants, and vesicants.
•Key Complications: Thrombosis, infection, and catheter malposition.
•Thrombosis Prevention: Use prophylactic anticoagulation in high-risk patients when indicated.
•Infection Prevention: Strict sterile protocols during insertion and dressing changes.
•Tip Confirmation: Ensure CAJ positioning using imaging techniques (X-ray or fluoroscopy).

Mnemonic for PICC Safety: “PICC SAFE”
•P: Position confirmed at CAJ.
•I: Infection control (sterile technique).
•C: Clot prevention (flush protocols).
•C: Chemotherapy compatibility.
•S: Secure the catheter.
•A: Assess thrombosis signs (arm swelling).
•F: Flush routinely.
•E: Educate patients on catheter care.

#HemeOnc #PICCLine #ChemoSafety #Complications

[Uriel Suárez @UsuarezMD]

Volume 2024 Issue 1 | Hematology, ASH Education Program | American Society of Hematology #ASH24 ⁦@Mohty_EBMT⁩ ⁦@TheIACH⁩

https://t.co/CATWQgKKgA

[Robert Z. Orlowski @Myeloma_Doc]

#Myeloma Paper of the Day: Response rate & EFS to 2nd line dara/bortez/dex in relapsed/refractory light chain AL #amyloidosis after initial bortez-based regime are better if prior response was CR/VGPR & if relapsed disease vs. inadequate prior response: https://t.co/Hw7Gx3a6yN.

[Raul Cordoba, MD, PhD #EHA2026 @DrRaulCordoba]

#Hematology Cardiovascular Management of Patients Undergoing Hematopoietic Stem Cell Transplantation: From Pretransplantation to Survivorship: A Scientific Statement From the ⁦@American_Heart⁩ Association | ⁦@CircAHA⁩ #CardioOnc #bmtsm #survonc https://t.co/p0KcOHwiIY

[GELTAMO @geltamo]

📘Ya tenemos disponible para su descarga la actualización de la "Guía de práctica clínica para el DIAGNÓSTICO, TRATAMIENTO Y SEGUIMIENTO DEL LINFOMA DE HODGKIN 2023". Encuéntrala en la web de GELTAMO. @geltamo @sehh_es @SEHHJoven
💻https://t.co/sHIRrlC2a2

[British Journal of Haematology @BrJHaem]

Idiopathic erythrocytosis: A diagnostic and management challenge with emerging areas for exploration
https://t.co/ZebFxP7yuQ

[Benlazar S M A @smbenlazar]

Aggressive T-cell lymphomas: 2024: Updates on diagnosis, risk stratification, and management | American Journal of Hematology | Blood Research Journal | Wiley Online Library https://t.co/c1dSXkYB3x #lymsm

[Multiple Myeloma Hub @MM_Hub]

💻 New user accounts 💻
Feature1️⃣️: Personalizing your areas of interest 🔍

Select a trial, congress, or any relevant #multiplemyeloma disease areas to the 'Areas of interest' section; this content will be used to suggest further recommendations.

https://t.co/7Z0XEPqI75
#ASH23

[Carloslp @Carl3roP]

@syed_abutalibmd @DamianoRondell1 @Ariel_Amaru @Poudyalbishesh @hidrhere @PalasseryRasmi @YStepanishyna @ASTCT @uiccom @UIC_CGH @UICHemOnc @BldCancerDoc congratulations

[Carloslp @Carl3roP]

@jose_rodguez83 Vamos con todo #TeamAsere , 🇨🇺🇨🇺🇨🇺 entera con ustedes.

[Carloslp @Carl3roP]

@farmacotips Cuba 🇨🇺🇨🇺